Management of Weight Regain Following Bariatric Surgery: Behavioral Intervention and Pharmacotherapy

ABSTRACT

Introduction

Bariatric surgery is the most effective intervention currently available for significant and durable weight loss, but weight regain after surgery is not uncommon. This paper focuses on updates in behavioral interventions and pharmacotherapy to combat weight regain after bariatric surgery.

Areas covered

This paper critically reviews both prospective and retrospective studies assessing pharmacotherapy in post-bariatric surgical patients published within the past 5 years. It also evaluates updates in behavioral therapies and delivery of the therapies in this patient population.

Expert opinion

Weight regain after bariatric surgery is common. Patients who experience weight regain should be evaluated and treated by a multidisciplinary team. Antiobesity pharmacotherapy should be considered for those who qualify as an adjunct to lifestyle modifications, along with behavioral interventions such as cognitive behavioral therapy.

KEYWORDS:

• antiobesity pharmacotherapy
• bariatric surgery
• behavioral interventions
• obesity
• pharmacotherapy
• weight gain
• weight management
• weight regain

Article highlights

• Bariatric surgery is an effective and durable option for the treatment of obesity

• Weight regain after bariatric surgery is common

• Patients who experience weight regain should be evaluated by a multidisciplinary team to assess factors leading to weight regain and to initiate behavioral, psychotherapeutic, or pharmacologic interventions, and to consider bariatric procedures and revisional surgery as appropriate

• Telemedicine improves access to treatment for post-surgical patients

• Post-procedure cognitive behavioral therapy and support groups appear to be effective interventions, and telemedicine may expand their reach

• Pharmacotherapy is a useful adjunct to behavioral interventions in post-surgical patients and can improve weight loss outcomes

• Weight loss outcomes following bariatric surgery can be optimized by initiating antiobesity pharmacotherapy when weight plateaus before individualized health and weight loss goals are achieved

Declaration of interest

KH Saunders reports ownership/stock/management interest in Intellihealth.

LJ Aronne reports receiving consulting fees from/and serving on advisory boards for Gelesis, Jamieson Wellness, Janssen Pharmaceuticals, Jazz Pharmaceuticals, Novo Nordisk, Pfizer, Real Appeal and Eli Lilly; receiving research funding from Allurion, Astra Zeneca, Gelesis, Janssen Pharmaceuticals, Novo Nordisk and Eli Lilly; having equity interests in Allurion, ERX Pharmaceuticals, Gelesis, Intellihealth, Jamieson Wellness, Myos Corp and Zafgen; and serving on a board of directors for Intellihealth and Jamieson Wellness.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.